Two transsexuals reflect on
university's pioneering gender dysphoria program

BY DAWN LEVY

Sandy Stone vividly recalls one day
in the '80s when she was leaving the stereo-repair shop where she
worked. A preoperative transsexual, she had moved to the beachfront
town of Santa Cruz, Calif., because it seemed a "fairly safe" place
to be during her two-year transition to feminine looks and
behavior. But that day her transitional look attracted the
attention of a transient. "What are you?!" he demanded to
know. "Find out," she replied. The man clutched his matted hair and
screamed, "You really make my head hurt, man! I can't figure you
out. Could you please just go away?" Stone retreated.

"What I did literally hurt him
because he lacked the mechanism to provide closure around some
plausible gender image," said Stone, a performance artist and
associate professor in new media at the University of Texas,
Austin. Stone's comments were part of an April 13 forum called "Sex
Change at Stanford: Historical and Personal Perspectives on
Stanford's Pioneering Gender Dysphoria Program, 1968-Present."
Coordinated by graduate student Ebony Chatman of the Department of
Modern Thought and Literature, the forum was sponsored by the
History Department, the Humanities Center and the Program in
Feminist Studies.

In the '60s and '70s, programs at
Stanford and other research universities were part of a brief but
important effort to better understand human sexuality. Stone and
others spoke about their experiences with the first sex-change
clinic on the West Coast, which Stanford opened in 1968 under the
direction of plastic surgeon Donald Laub. Psychiatrist Norman Fisk,
now retired, also guided the program. Since 1980, the clinic has
existed as a nonprofit foundation in Palo Alto, Calif., and is not
affiliated with the university.

Laub, 65 and semi-retired, still
runs the Palo Alto program and continues to treat both
female-to-male (FTM) and male-to-female (MTF) transsexuality, or
"gender identity disorder." Another synonym, "gender dysphoria,"
emphasizes the anguish that results when a person's psychological
sex, or gender, does not match his or her physiological sex, or
body. Roughly one in 30,000 adult males and one in 100,000 adult
females seek sex reassignment surgery, according to the
Diagnostic and Statistical Manual of Mental
Disorders.

Writer Jamison Green was born in a
female body. "Although I was always male-gendered, I never really
felt like I was born into the wrong body, exactly," he told the
Stanford audience. "Rather than saying there was something 'wrong'
with me, I'm saying there was something unbalanced about me." Green
is former president of FTM International, the nation's largest
advocacy and support group for female-to-male transsexuals. "There
is just a huge amount of variety and diversity among human beings,"
he said. "I am privileged to be able to change my sex to make my
gender and body line up."

There always have been people who
felt or acted as if they were the other sex, said Indiana
University history Professor Joanne Meyerowitz, who earned her
doctorate at Stanford and who is writing a history of
transsexuality in the United States for Harvard University Press.
But only in modern times have transgendered people been able to ask
the scientific community to use hormones and surgery to realign sex
and gender.

These transformations first took
place at the hands of European doctors. On Dec. 1, 1952, the New
York Daily News published a first account of a transsexual
American, Christine Jorgensen. The front-page story -- "Ex-GI
Becomes Blonde Beauty" -- told of Jorgensen's journey to Denmark
for a rare and complicated treatment.

The 1960s was an era of big funding
for medical research, Meyerowitz said. In this context some doctors
began to organize research programs and treatment clinics for
transsexuality. The programs were highly controversial, she said:
"The American Medical Association didn't back them and government
agencies didn't fund them."

The initial money came from a
wealthy female-to-male transsexual, Reid Erickson, who founded the
Erickson Educational Foundation in 1964. Erickson had been a
patient of German-born endocrinologist Harry Benjamin, who emerged
as an advocate for American transsexuals in the early 1950s. Today
the Harry Benjamin International Gender Dysphoria Association Inc.,
an organization of medical and mental health professionals,
publishes internationally accepted guidelines for the treatment of
gender identity disorders.

Erickson had a hysterectomy at Johns
Hopkins University, after which he funded both Benjamin's research
and the Johns Hopkins program, the first university-based
transsexual surgery clinic in the United States. It opened in 1966,
followed closely by programs at the University of Minnesota,
Northwestern University and Stanford.

University-based programs provided
professional legitimization and created new knowledge through
research. But doctors had to set up a gatekeeping system to allow
them "to control access to treatment and to protect their
professional reputations in a controversial field," said forum
moderator Susan Stryker, a Social Science Research Council
Postdoctoral Fellow in Sexuality Studies at the University of
California, Berkeley.

The gatekeeping system created a
close but contentious relationship between the service providers
and people who demanded hormones and surgery to create the sense of
self they needed. "But it was driven by consumer demand," Stryker
said. "No one was out there saying, 'Oh, I think it'd be
interesting to do these things to people.' If people weren't asking
for it, the services would not have been provided."

In the '80s, most gender dysphoria
programs left the domain of universities for reasons that remain
unclear. Historian Meyerowitz said controversy killed many
university-based programs, but Judy Van Maasdam, coordinator of
Laub's Gender Dysphoria Program, said in a phone interview that
most folded when their founders -- often chiefs of plastic surgery
-- left for private practice. Today, the only university-based
program still in existence is at the University of Minnesota, and
it does not include surgery.

Nonetheless, most people who qualify
can get sex-change surgeries, Van Maasdam said. Patients still can
get surgeries at many university hospitals, including Stanford
Medical Center, she said. To qualify, they must have two
endorsements -- one from a doctoral-level (Ph.D. or M.D.)
professional, one from a master's-level professional.

About 2,000 people have been through
the counseling phase of the program that began at Stanford. About
600 have had genital surgery, according to Van Maasdam.

The MTF genital surgery --
vaginoplasty, or vaginal construction -- costs about $12,000 for a
type of skin graft called a penile inversion or $28,000 for a
"rectosigmoid transfer" procedure, in which surgeons use rectal
tissue to construct a vagina, Van Maasdam said. FTM surgeries range
from $6,000 for a mastectomy to $80,000 for construction of a penis
capable of achieving erection and permitting a person to urinate
while standing. Some insurances will cover the cost of surgery, she
said. While vaginoplasty is "state of the art," she said, penis
construction "still has a ways to go."

Sandy Stone: A male-to-female
experience

The path to Stanford was not a
straight one for Sandy Stone, who went through the Stanford program
in the '70s.

"I went from being a Jewish prince
after bar mitzvah to being a neurologist and then a rock-and-roll
engineer and then a filmmaker and then a sex change and then a
lesbian separatist and ultimately wound up in a heterosexual
marriage," she told the Stanford audience. "It's been something of
an amusement park ride.

"My awareness that there was
something quote 'different' about me started when I was 4 or 5
years old, back before we had clearly formed ideas of what sex and
gender really are," Stone said. "I dreamed that I was climbing
mountains and swimming rivers and doing all sorts of other
activities usually the province of male athletes, except that in my
dream I was doing these in the company of women. And when I looked
at myself in the dream, I was a little girl."

By puberty she was in crisis as she
tried to suppress expression of her gender. "If you're secretive
about it and you're a male-to-female potentially, you buy women's
clothing," she said. "You'll hide them in little compartments on
the roof. You'll hide them in the car. If you're really daring you
start wearing women's clothing under your male clothing. Not
everyone can be so daring. And then all of a sudden you wake up one
morning and say, 'Oh, my God! What am I doing?' You find it all . .
. and you throw it away. Or you burn it. You do some act of
excision. You get it out of your life. You close that off forever,
rebuild that barrier. 'I'm never going back. Everything is OK now.
I'm just another guy.' Oh, it feels so good! That lasts usually for
about 90 days."

The cycle repeated itself for years
until one midlife morning when Stone woke up and thought: "My God!
I'm going to die in this body unless I do something about
this!"

At this point Stone called a society
for transgendered individuals and found out about the Stanford
program.

"Stanford is presented to me as a
place where one goes if one is very small, very willowy, very
blonde, likes to wear high heels and heavy makeup," she said. "'You
must blend in the population. We hope you get married.' (I did, but
I didn't expect to.) I think, 'Hot diggity dog! I am about as far
from this as anyone can possibly be.'"

Stone's first meeting with Stanford
surgeon Laub foreshadowed clashes to come. "I looked at Don, and
Don looked at me, and we had this mutual moment of regard. I at the
time was wearing jeans, engineer's boots and had a long beard. I
said in my best macho engineer voice, 'I am interested in a sex
change.' He said, 'To what?'"

Stone entered the program, which
employs a coordinator, a psychologist, a psychiatrist, a surgeon
and other professionals to help patients during their transitions.
Counseling, hormones and living in a feminine gender for two years
were part of Stone's regimen.

She and Laub butted heads regularly
over what passed for femininity. A standard interview, Stone said,
went as follows: "I sit down. Don says, 'Why aren't you dressed
like a woman?' I look down. I'm wearing jeans and a T-shirt. I say,
'I am dressed like a woman.' Don says, 'No, you're not.' I
say, 'Have you looked out the window recently?'"

The program's focus on "passability"
expired with the '70s, Van Maasdam said. The current program
focuses on adaptation to the gender role while acknowledging that
there's no such thing as a "classic" transsexual.

When the time came for her
sex-change operation, Stone said Laub asked her if she was "100
percent sure" that she wanted surgery. "I said, 'No, I'm not.' I
felt 99 percent sure. I think anybody who's 100 percent sure
of anything is probably crazy. I mean, we all have doubts. I said,
'I'm an adult. I can take responsibility for my actions. This is
informed consent. If I made a mistake, it's my fault, not yours.
Let's go.' Don said, 'I'm sorry. You're not eligible.' So I went
home."

Three months later Stone got a call
from the program coordinator to rescript the meeting. "This time
both of us are prompted," Stone said. "Each of us needs a
particular thing. I don't want to be thought of as crazy. Don
doesn't want to have to let go of control. So we go in there into a
room, and this time things go much better. Don says, quote, 'Are
you ready for surgery?' I say, quote, 'Yes.'"

The rest, as they say, is herstory.
But Stone's long, strange trip didn't end with the operation that
aligned gender with genitalia. "One of the things I did try to do
[before surgery] was duplicate [writer] Jan Morris's experience of
going to the mirror and giving her old self a wink for luck because
it was the last time they would ever meet," Stone said. "So a week
or two later [after the surgery], I went to the mirror and it was
still me, and I felt like I'd done something terribly wrong. But
it's been me ever since."

Stone said she is continually
challenged by real problems in a world where "nothing is clear, the
lines are extraordinarily difficult to find and the important thing
is not what sex are you, but what kind of a person are you? What
kind of a life do you want to craft for yourself? In a world filled
with people who attempt to erect walls against the possibility of
divergence, of gradations of difference, how can we find ways to
live well and to be fully human? My problem, I think, as well as
yours."

Jamison Green: A female-to-male
experience

"When I showed up at the Stanford
clinic, it was 1988," Jamison Green told the audience. "How I came
there was through years of fear. And also years of wanting to be
legitimate in some way."

Born in 1948, Green knew the term
transsexual by the time he was 20 years old. "I was scared
to death to think that it might apply to me. But by the time I was
27, I had pretty much accepted that I probably was a
transsexual."

At this point, he said, he still did
not know it was possible to change from female to male. When he was
about 28, he met a female-to-male transsexual in Oregon who, like
Green, was living in the lesbian world. Green's friend had chest
reconstruction and hormones from the University of Oregon but to
this day has not had genital reconstruction. Though Green was
raised in the Bay Area, he heard about the Stanford program from
his friend: "He wanted genital reconstruction from Dr. Laub here at
Stanford. He had done all the research that he could possibly do.
He said that Laub was the best, no two ways about it, and at the
time he was talking to me as if I was going to do this
someday."

Ten years passed, Green said,
"before it sunk in real hard, through a number of events in my
life, that the only way that I was going to grow up was to become a
man, that I was never going to be an adult woman. It simply wasn't
going to happen."

So he moved back to the Bay Area and
requested an application for the Stanford-born program. "It came in
the mail at 16 pages long," Green recalled. "I just flipped out and
put it in a desk drawer. It sat there for two years before I had
the guts to fill it out. Lest you think that people who have sex
change make an instant, overnight decision, this is a long,
drawn-out process."

In 1987 Green began meeting with a
transsexual support group that ranged in size from four to 18 and
that was started by Lou Sullivan, publisher of The FTM
Newsletter.

"Lou had identified as gay," Green
recalled. "This was unheard of in gender programs, which basically
had a model of people that they would allow to have surgery, and
that included people who were going to be heterosexual afterward,
people who were not going to contact other transsexuals and urge
them to do anything that might be considered political. So Lou had
been turned down by the Stanford program."

The guest speaker at Green's first
support-group meeting was Steve Dain, the first prominent FTM
transsexual in the United States. Dain, who had been a girls'
physical education teacher in Emeryville, Calif., went through his
transition in the mid-1970s and lost his job as a result. In Dain's
poise, intelligence and appearance, Green saw a role
model.

Dain, who had been through the
Stanford program, answered many of Green's questions. "He really,
really admired and appreciated Dr. Laub. Dr. Laub was one of two
surgeons who independently and simultaneously developed a new
technique for creating the male genitalia in female-bodied people
that was not very invasive and that created an organ that actually
could have sexual function and was naturally erectile and
completely orgasmic, whereas most phalloplasty techniques were
prohibitively expensive if you wanted any kind of erotic
sensation," Green said. "That was a problem for a lot of
female-to-male people, which is one reason why a lot of
female-to-males don't have genital reconstruction."

Green finally decided to fill out
the program application. "I mailed it in and got an appointment and
I actually was treated extremely well." He liked the program's
emphasis on "just plain day-to-day stability in one's life. In
other words, to show that one could actually negotiate the
transition. People have often said that clinics tell you that you
have to lie about your past and tell no one that you've done this:
Get a new job, get all new relatives, destroy all your
photographs, change your whole life. And what I was told was
that if you have the strength to be present when people know about
your past, if you have the strength to know that people are talking
about you behind your back, then stay in your job. Do it. Because
that's what people are going to do. You're going to be the freak in
the room, and if you're strong enough to deal with that, then
that's fine. So that's what I did."

Sullivan died in 1991. Before he
did, he asked Green to take over publishing a quarterly newsletter
that went out to about 230 transgendered people worldwide who were
geographically isolated from a peer group. "I began to hear other
people's stories," he said. "They would call me up. They would
write letters. And I'd hear the shame and fear that people
expressed about living their life as someone who's gone through sex
reassignment. And what I did with that information was say, I can't
live like this. It is wrong for people to live in a state of fear
and shame. I have to get over my own transphobia, my own
internalized fear of being perceived as being a 'professional
transsexual,' which was the big phrase that everyone was supposed
to avoid, and I have to live as if it is OK to be someone like
me."

He began conducting civil rights
work on behalf of transsexuals. "For me it's all about the essence
of human dignity. I think the Stanford program started out and
actually still at core follows an edict or ethos of human dignity
-- basically has tried to improve the lives of the people who have
these issues in their life. And I think it's an extremely important
service that's being done. It certainly has done wonders for my
life. I have an incredible life right now, I've got to tell you."
SR